FEP Claims Operations Leader – Hybrid/Remote

Blue Cross and Blue Shield of North Carolina; North Carolina; Hybrid; USD 108,000 - 173,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k match

Paid Time Off

Job summary

Blue Cross NC is seeking a seasoned FEP Manager, Claims to lead end-to-end claims operations across provider segments and deliver against business targets. You’ll drive processing, refunds, and recovery, while ensuring accurate financial reporting and strong customer service.

The role requires 8+ years in related fields and a Bachelor’s degree (or 10+ years of experience in lieu of degree). Hybrid work from Durham area with national remote options available.

Qualifications

• Strong knowledge of healthcare claims processing, recovery, refunds, and/or appeals.
• Experience with claims accounting, financial reconciliation, or financial reporting.
• Familiarity with Blue Cross Blue Shield plans, CMS, or other highly regulated healthcare environments.
• Experience leading high-volume claims operations teams, including team leads or people managers.
• Demonstrated success with process improvement, operational efficiency, and claims quality initiatives.

Responsibilities

• Streamline shared processing to reduce management by exception.
• Set operational process to address market trends, BCBSNC capabilities and customer demand.
• Oversee accounting and financial reporting functions, ensuring compliance with accounting principles and standards.
• Research and resolve banking issues.
• Participate in projects to improve claims processing, recovery, and accounting functions.
• Manage financial recovery activities including refunds and collections.
• Lead team leads and staff to maintain high utilization and engagement.
• Resolve complex claims appeals by coordinating with stakeholders for high-value claims.
• Collaborate with Audit and Payment Integrity to sustain accuracy and quality.
• Design and develop tools and techniques for improvements.
• Identify needed process and procedural changes to improve customer satisfaction.
• Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS with Sales.
• Represent FEP Claims Operations as SME and single point of contact for escalations.

Skills

Claims processing

Financial reporting

Team leadership

Process improvement

Stakeholder collaboration

Education

Bachelor's degree or advanced degree

10+ years of experience in related field in lieu of degree

Job description

Blue Cross NC is seeking a seasoned FEP Manager, Claims to lead end-to-end claims operations across provider segments and deliver against business targets. You’ll drive processing, refunds, and recovery, while ensuring accurate financial reporting and strong customer service.

The role requires 8+ years in related fields and a Bachelor’s degree (or 10+ years of experience in lieu of degree). Hybrid work from Durham area with national remote options available.